Healthcare Provider Details

I. General information

NPI: 1285577155
Provider Name (Legal Business Name): AHMAD ZEITOUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 W SOUTHERN AVE
MESA AZ
85210-5005
US

IV. Provider business mailing address

6932 E SUGARLOAF CIR
MESA AZ
85207-0937
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-5817
  • Fax:
Mailing address:
  • Phone: 480-516-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number279941
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: